11D2092853 CLIA NUMBER - JACOBS CLINIC, INC

Laboratory Demographics

  • CLIA Code: 11D2092853
  • Facility Name: JACOBS CLINIC, INC
  • Facility Address: 403A LISTER STREET
    WAYCROSS, GA
    ZIP 31501
  • Facility Phone: 000 912-2834
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: ROBERT S. JACOBS
  • NPI Number: 1033508791
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 11D2092853
LAB Type Practitioner Other
Facility Name JACOBS CLINIC, INC
Street 403A LISTER STREET
City WAYCROSS
State GA
ZIP 31501
Phone 000 912-2834
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/16/2025
Certificate Expiration Date 3/15/2027
Facility Type Practitioner Other
Lab Director ROBERT S. JACOBS

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This page was last updated on: 9/29/2025